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AHM-250 Healthcare Management: An Introduction is now Stable and With Pass Result | Test Your Knowledge for Free

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AHM-250 Practice Questions

Healthcare Management: An Introduction

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Total Questions : 367

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Question # 41

The contract between the Honolulu MCO and Beverley Hills Hospital contains a 90 day cure provision. The Beverley Hills Hospital breached one of the contract requirements on July 31, 2004. The hospital remedied the problem by October 31, 2004. Which of the

Options:

A.  

The contract would not be terminated as Beverley Hills hospital rectified the problem within 90 days.

B.  

The contract would be terminated as Beverley Hills hospital was required to notify Honolulu MCO about the problem at least 90 days in advance.

C.  

The contract would be terminated as Beverley Hills hospital was required to rectify the problem within 90 days.

D.  

The contract would not be terminated as Beverley Hills hospital may escape adherence to the cure provision.

Discussion 0
Question # 42

One non-group market segment to which health plans market health plan products is the senior market, which is comprised mostly of persons over age 65 who are eligible for Medicare benefits. One factor that affects a health plan's efforts to market to the

Options:

A.  

The Centers for Medicare and Medicaid Services (CMS) must approve all marketing materials used by health plans to market health plan products to the Medicare population

B.  

managed Medicare plans typically require Medicare beneficiaries to purchase Medigap insurance to supplement gaps in coverage

C.  

managed Medicare plans can refuse to cover persons with certain health problems

D.  

the CMS prohibits health plans from using telemarketing to market health plan products to the Medicare population

Discussion 0
Question # 43

One typical characteristic of preferred provider organization (PPO) benefit plans is that PPOs:

Options:

A.  

Assume full financial risk for arranging medical services for their members.

B.  

Require plan members to obtain a referral before getting medical services from specialists.

C.  

Use a capitation arrangement, instead of a fee schedule, to reimburse physicians.

D.  

Offer some coverage, although at a higher cost, for plan members who choose to use the services of non-network providers.

Discussion 0
Question # 44

Janet Riva is covered by a traditional indemnity health insurance plan that specifies a $250 deductible and includes a 20% coinsurance provision. When Ms. Riva was hospitalized, she incurred $2,500 in medical expenses that were covered by her health plan.

Options:

A.  

$1,750

B.  

$1,800

C.  

$2,000

D.  

$2,250

Discussion 0
Question # 45

Individuals can use HSAs to pay for the following types of health coverage:.

Options:

A.  

Qualified disability insurance

B.  

COBRA continuation coverage.

C.  

Medigap coverage (for those over 65).

D.  

All of the above.

Discussion 0
Question # 46

In the paragraph below, two statements each contain a pair of terms enclosed in parentheses. Determine which term correctly completes each statement. Then select the answer choice containing the two terms that you have chosen. For providers, (operational /

Options:

A.  

operational / an acquisition

B.  

operational / a consolidation

C.  

structural / an acquisition

D.  

structural / a consolidation

Discussion 0
Question # 47

The Ark Health Plan, is currently recruiting providers in preparation for its expansion into a new service area. A recruiter for Ark has been meeting with Dr. Nan Shea, a pediatrician who practices in Ark's new service area, in order to convince her to be

Options:

A.  

Credentialing

B.  

Accreditation

C.  

A sentinel event

D.  

A screening program

Discussion 0
Question # 48

One true statement about community rating, a rating method commonly used by health plans, is that:

Options:

A.  

It requires a health plan to set premiums for financing medical care according to the health plan's expected cost of providing medical benefits to a sub-group within the community.

B.  

A health plan usually uses community rating to set premiums for large groups.

C.  

It tends to lead to greater fluctuations in premium rates than do other rating methods.

D.  

A health plan seldom uses community rating to set premiums for large groups.

Discussion 0
Question # 49

The following programs are part of the Alcove Health Plan's utilization management (UM) program:

  • Preventive care initiatives
  • A telephone triage program
  • A shared decision-making program
  • A self-care program

With regard to the UM programs, it is most

Options:

A.  

Preventive care initiatives include immunization programs but not health promotion programs.

B.  

Telephone triage program is staffed by physicians only.

C.  

Shared decision-making program is appropriate for virtually any medical condition.

D.  

Self-care program is intended to complement physicians' services, rather than to supersede or eliminate these services.

Discussion 0
Question # 50

One device that PBM plans use to manage both the cost and use of pharmaceuticals is a formulary. A formulary is defined as

Options:

A.  

a listing of drugs classified by therapeutic category or disease class that are considered preferred therapy for a given managed population and that are to be used by a health plan's providers in prescribing medications

B.  

a reduction in the price of a particular pharmaceutical obtained by the PBM from the pharmaceutical manufacturer

C.  

drugs ordered and delivered through the mail to the PBM's plan members at a reduced cost

D.  

an identification card issued by the PBM to its plan members

Discussion 0
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